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Indian Journal of Community Medicine

Medical Education: Our Current Concern

Author(s): PM Durgawale, PP Durgawale

Vol. 31, No. 3 (2006-07 - 2006-09)

PM Durgawale* PP Durgawale**

As against 30 medical colleges at the time of independence, India is now having 231 medical colleges (2003) with an annual turn out of about 24000 graduates every year. However, the system of Medical Education, which was basically westernized and hospital oriented since its origin about 150 years ago has not undergone the desired changes as per recommendations of various committees in the past. Most of the recommendations remained on paper only and could not be transformed into actual practice effectively. The medical education in India therefore still remains a subject for all round criticism particularly in the light of so much importance being attached to production of basic doctors, competent enough to provide primary health care and thus play an effective role in realizing the health goals. Various surveys/studies carried out in the recent past., however, portray a very dismal picture. According to WHO (SEARO) the reorientation of medical education should be problem-based learning but unfortunately the findings of these surveys/studies are quite contradictory. For example a study undertaken by NIHFW during 1988-89 in respect of 44 medical colleges revealed that the urgency of HFA goals were not reflected in the curriculum planning, and even the teachers were not oriented towards the priority needs of HFA and maternal and child health. Besides this, they also noted a shortage of staff in crucial department like Preventive & Social Medicine, lack of coordination between district authorities and medical colleges and posting of students for community work for only one to three months by some medical colleges instead of 6 months as prescribed by the Medical Council of India. It was disheartening to note that about 30% students had not performed simple procedures like recording the weight of mother and infant, 30-40 percent had never given any immunization, about 70% had never prescribed common contraceptive methods like condom or oral pill and about 60 % could not explain correctly the Health for All goals and components of primary health care.

According to Dr. P. V. Sathe, the Ex- Director of Medical Education and Research Maharashtra, although the MCI has stipulated the curriculum and minimum requirements for ensuring a strong health care, base to medical education fails in exposing medical students to the principles and practice of preventive and social medicine right from the pre clinical period. But most medical colleges are still unable to have excellent community oriented field based programmes for demonstration and participatory education of the undergraduates. According to him, medical colleges, by and large, remain isolated from health care system and play very limited role in public health services. Rural works, preventive activities are not attractive to interns who are not motivated at the end of their undergraduate days to derive maximum advantage, moreover they feel that 6 months period of rural internship is too long period which deprives them of the clinical experience in hospitals which they value more. The net result is an unsatisfactory undergraduate training, which does not make them feel competent enough for discharging their public health duties. He also blames the medical officers of public health department under whom the interns get attached and the teachers in medical colleges for their lack of interest in discharging their role effectively in the training of undergraduates and interns.

According to one more critic, Smt. Ela Bhatt of Self Employed Women’s Association (SEWA) Ahmedabad, the aim of professional education in health must be production of a cadre of professionals who would have competence as well as motivation to serve the health needs of the country and its people as a whole. Unfortunately, the number and type of medical training institutions in India is entirely disproportionate to the actual needs of the vast majority of people. The medical profession has equated health with illness, doctors, hospitals, drugs, technology and converted illness into creative business and industry and surprisingly, the medical education plays a key roll in perpetuating this system. The glamorous high tech and uncreative fields like medicine and surgery and their super specialties like cardiology, plastic surgery are the first choice of the students and certainly not the subject of Preventive and Social Medicine. These are the main reasons for lack of production of basic doctors required for our rural areas, the primary health centers, and the peripheral infrastructure for provision of primary health care. According to her the medical education should have been planned and implemented keeping the needs of the people at the forefront but unfortunately the MCI has failed to provide the leadership, guidance, monitoring of medical education and practices, and therefore needs a radical change in its role and functioning.

All above considerations call for an immediate introspection in the field of medical education and pay a serious thought in bringing about drastic changes advocated by many critics earlier, after due consideration to both plus and minus sides. In respect of some recommendations, however, there is no controversy, e.g., a greater importance on teaching of Community Medicine is certainly required. A greater emphasis needs to be placed on MCH and family welfare, tropical diseases, various national programmes, nutrition etc. A greater emphasis on more fieldwork is required particularly during the 6 months period of internship, which should not be curtailed at any cost. It should be regarded as the most crucial period to impart problem based learning and problem solving approach. Greater importance needs to be given to community based education rather than institution or hospital-based education. The overall shortage of senior and experienced teacher should be immediately solved, as majority of teachers today are junior teachers although with Post Graduate qualification but hardly any experience in the field and usually with teaching experience of less than 5 years. The NIHF study carried out during 1988-89 has specially recommended a competence based curriculum (CBC) to lay emphasis on skill building and refraining of assessment methods, teachers should interact and participate in delivery of National Health Programmes, Community orientation of students should be started from inception, the Medical Education Cell (MEC) may be created in each medical college for planning, implementation and monitoring of the curriculum, and the internship training should be revamped so that it is not just a repeat learning of the skills but should be aimed at delivery of health services.

And lastly it is of paramount importance to make the rural health services more attractive (position, pay, facilities and job satisfaction wise) to motivate the young medical doctors to come forward and discharge their role as basic doctors in providing Primary Health Care to the rural masses and thus help in realizing the dream of health for all.

References

  1. WHO Reorientation of medical education: Introducing problem based learning in SEA region 1992.
  2. NIHFW Health and Population: Perspectives and issues. Vol. 12 1989.
  3. ISHA Health Administrator, Vo1.2 No. 1. 1991, Special issue theme: Health policy, achievements and issues in public health care in India.
  4. Sathe PV and Sathe AP Epidemiology and Management for Health Care for All. Published by Popular Prakashan Pvt. Ltd, Tardev. Bombay 1991. 400 034.
  5. Bhatt Ela Making Medical Education Relevant to the needs of India. Indian Journal Of Community Medicine (1992).
  6. NIHFW Undergraduate Medical Education Training in MCH & Family Welfare in Medical Colleges. News Bulletin. Vol, 3 1990.

*Dept. of Community Medicine,
**Dept. of Biochemistry
Krishna Institute of Medical Sciences, D.U. Karad.

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